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What was your response to this article
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Re: What was your response to this article - September 10, 2005 5:06:00 PM
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jma
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Rarely does one with back pain get only one session of PT. So for them to say that there is no difference between a consulation and one intervention for this does not flow. Especially for pain greater than 6 weeks.
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Re: What was your response to this article - September 10, 2005 5:37:00 PM
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Jon Newman
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A great discussion of this occurred at NOI. [URL=http://www.noigroup.com/cgi-bin/ubbcgi/ultimatebb.cgi?ubb=get_topic;f=5;t=000086]Here's the link.[/URL]
Bill Eagan did a great analysis.
And then later, in another thread, Bob Nee provided [URL=http://www.noigroup.com/cgi-bin/ubbcgi/ultimatebb.cgi?ubb=get_topic;f=5;t=000091]this.[/URL]
jon
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Re: What was your response to this article - September 12, 2005 5:03:00 AM
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Shill
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The problem is that you can send 10 patients with LBP to 10 therapists, and they may get 10 completely different programs. That is just plain wrong. With that kind of stuff going on, how can "routine physical therapy" even be studied? We need stronger standards of care.
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Steve Hill PT
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Re: What was your response to this article - September 12, 2005 6:23:00 AM
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JLS_PT_OCS
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Steve-
By standards of care, do you mean a reduction in our practice variation or do you mean accepting only a few people for LBP treatment in PT?
I think Barrett makes a good point when he talks about how as the uncertainty for treating a given problem increases, so too do the numbers of proposed treatments. Or something like that.
With the current state of evidence in LBP care (which is not the fault of the therapists), we could probably make a strong argument for several different approaches. I use routinely high and low velocity spinal manual therapy, a lot of ergonomic and biomechanics advice, lumbar stabilization with both local/specific/highly supervised exercise and global/general/mostly unsupervised exercise, neuromobs for those with LE symptoms, pain education, graded cardio exercise, and the occasional trial of electrotherapy or traction (when I'm desperate and/or patient in acute pain). I think there is some evidence to support all these approaches.
Look forward to reading the responses on NOI (thanks for the link Jon).
J
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Jason Silvernail DPT, OCS, CSCS
"It isn't what you're able to do that requires your courage but rather what you have come to understand and are willing to express." - Barrett Dorko,PT
**I no longer post on RehabEdge**
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Re: What was your response to this article - September 12, 2005 7:15:00 AM
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kragar
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Well I am not sure the evidence is all that convincing for a 'multilayered' approach Perhaps all that is truly needed is instruction on how the patient should advance exercise and activity and how to prevent future occurances. That really is the only evidence that is convincing. I wish I could say "treatment A" is truly beneficial...but there really hasn't been convincing evidence at all.
As far as patient satisfaction, "hands on" is the way to go. So it comes down to EBM vs patient satisfaction.
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You're my boy Blue!
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Re: What was your response to this article - September 12, 2005 7:54:00 AM
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Shill
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Jason,
[QUOTE] reduction in our practice variation [/QUOTE]This is precisely what I mean.
Kragar - It would be nice if we actually had something that was proven to prevent recurrence, or even to reduce recurrence chances, but I dont believe that anyone, anywhere, in any field, has shown a reliable prevention tool. We all THINK we can, but what do we KNOW prevents recurrence?
(Other than death, mind you)
Steve
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Re: What was your response to this article - September 12, 2005 8:59:00 AM
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Jon Newman
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I think the best way to reduce practice variation is to have an underlying theory driving practice and research in the first place. If we look at physics, chemistry and biology, they all have theory underlying research that is just as important as determining if something works. What would these sciences look like without theory driving their research?
jon
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[URL=http://www.sonymusic.com/clips/selection/30/064887/064887_03_03_30.wav]Evidence[/URL]
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Re: What was your response to this article - October 7, 2005 3:14:00 PM
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Rehab Outcomes
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Apologise for jumping in at a late stage here, but I feel compelled to state the obvious:
This research only provides evidence that delayed and shortened physiotherapy (as seems to have occured within the methods) is no better than early advice. Indeed should the title really be "NHS Physiotherapy compared with advice for LBP"?
Brad
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Re: What was your response to this article - October 7, 2005 5:45:00 PM
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drbuddy
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They do this with spinal manipulation too. Treat the person 3 times for one week and follow up 2 years later.
Hey, wow, outcomes are the same as just giving them an educational booklet. What a suprise. You might as well stick a carrot in their ear for a few minutes and then they can title the article "New Cost Effective Technique Shown to be as Effective as Spinal Manipulation".
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Re: What was your response to this article - October 8, 2005 2:54:00 AM
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jma
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Yes, they should have renamed the title of the paper.
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